Democratization in Microsurgery: The Proximie System

Democratization is a noun. The meaning of democratization as it pertains to microsurgery is the action of making training and education available through technology, in this case, microsurgery in breast reconstruction. The chosen field of microsurgery requires hours of training and practice. Observing colleagues perform this sophisticated and complex surgery increases their own skill set with the primary goal being improving patient outcomes in breast reconstruction. My guests are going to discuss their cross-continental experience working live in the operating theater practicing democratization in microsurgery using the Proximie System.

An Introduction of the Microsurgeons Using the Proximie System

I invited back to the DiepCJourney podcast two internationally known microsurgeons. Dr. Joe Dusseldorp practices in Sydney, Australia and is a fellow of the Royal Australasian College of surgeons. He has a keen interest in microsurgery and did his training overseas to achieve this status. He is also trained to do robotic assisted surgery and is accredited in this specialty in microsurgery.

Dr. Minas Chrysopoulo is the current president of PRMA in San Antonio, Texas, and founder of the Breast Advocate®, a free shared decision-making app for breast cancer surgery and breast reconstruction. He holds a board certification in plastic surgery. As he states, board certification matters in your relevant field. Dr. C underwent further training in microsurgery that included burns and hand which led him to microsurgical breast reconstruction. Breast reconstruction is the core of his practice with his team member surgeons at PRMA.

An Invitation to Join a Robotic Assisted DIEP flap via Proximie

Dr. Joe invited Dr. C to join him live in the operating theater using the Proximie technology system to observe a robotic assisted DIEP flap breast reconstruction. When you hear the term “mate” from a London born microsurgeon, Dr. C, referring to Dr. Joe in Sydney, you know they have become colleagues in surgery as well as friends who have a passion for providing the best outcomes for breast cancer patients in breast reconstructive surgery.

He revealed that he was not sure the collaboration was even going to work. It was the first time he had used the Proximie system in real time in the OR with another chosen colleague, in this case, Dr. C. Dr. Joe reflects on times when colleagues at his cancer center would demonstrate surgical techniques at conferences with those observing sitting in an auditorium, sometimes a football field length away from the actual surgery watching the surgery on a screen.

What genuinely interested Dr. Joe aside from the live streaming capability was that he could record what he was doing in the operating theater with Proximie knowing he could go back and review it for his own purposes. The Proximie team informed him he could invite anyone who had an internet connection with no need to download anything. He says it was quite an offhand invitation to Dr. C and on very short notice within a day or two of the planned surgery. He carefully looked at the time difference when sending him the invitation to join.

Dr. C Accepts the Invitation to Utilize Democratization in Microsurgery via the Proximie System

As Dr. Joe was doing narrative during the surgery, not knowing if Dr. C would join or not, he was surprised when “all of a sudden this guy’s head pops up on the screen.” Next thing he hears is a voice saying, “Hey mate, how are you going?” He arrived in time to see Dr. Joe put the ports in before heading over to the robot to begin work on the robotic assisted DIEP flap. He could hear him talking through the headphones of the Proximie system. It seemed as if Dr. C were right in the room with him.

Dr. C admitted he was a little concerned looking at a couple of emails before the event with the Proximie team. He smiles and says he thought perhaps they felt he was not technologically savvy, but Dr. Joe chimed in and says, “It’s OK, he can work it out. It’s fine. Just send him the bloody link.” Dr. C follows on a serious note by saying how simple and seamless it was and a wonderful experience.

He describes seeing everything in incredible detail. The ability to learn in this fashion vs. getting on planes and traveling that includes time and expense, he felt was truly phenomenal. The success defining portions of the surgery can be utilized through the feature of recording the operation, maximizing education. The value of having these two experts being in the OR together enhanced the learning capabilities through the Proximie system allowing them to innovate in real time. It is worth it to view the video of Dr. Joe’s DIEP flap via the DiepCFoundation educational channel.

Why Obsession with Nerves is Important in DIEP Flap Surgery

It is important to minimize the damage to the abdominal wall during DIEP. Merely saving muscle is not the only thing that should be focused on. As Dr. C points out, they have ways of minimizing “the hit” the belly or abdominal wall takes during DIEP flap. The motor nerves powering the muscles should be preserved to avoid bulges and hernias from forming. He and Dr. Joe both agree they are two microsurgeons who are obsessed with preserving nerves in breast reconstruction. This is the reason they originally connected.

Preserving the nerves and minimizing damage to the abdominal wall can be done with or without the robot. Dr. Joe and Dr. C tell us that robotic assisted DIEP flap is not for everyone. Some patients are not candidates. However, for those that are, they both feel having this option and having surgeons add it to their armamentarium is important for those patients who do qualify and for optimizing patient outcomes.

The SIEA Vessel in Microsurgery

Dr. Joe and Dr. C talk discuss the value of microsurgeons looking for the SIEA vessel. Why? The SIEA vessel runs through the facial tissue from the groin. Instead of traveling through the muscle, they travel on top of the musculature and the sheath supplying the fatty layer under the skin directly without perforating the muscle. The DIEP flap is a perforator flap where the vessels perforate the flap. The SIEA artery that does not enter the muscle at all. Dr. C points out that patients should have two criteria if the SIEA are going to be considered for use in DIEP flap.

• The patient must present with a SIEA vessel.
• The SIEA needs to be large enough to use with great consideration given to the branching pattern of the vessels into the tissue.

Through the use of various tools in the OR, like the SPY technology to evaluate the blood vessels, they both agree that careful consideration should be given to utilize the SIEA vessels in breast reconstruction. Experience counts!

Proximie: The Way Forward in Surgical Education

Dr. Joe and Dr. C both say this is the way forward, democratization in surgery, allowing more surgeons to train in real time, avoiding the need to travel and take them away from their patients and time in clinic and the OR. Dr. C wrapped up their experience using Proximie in a very thoughtful statement.

When you’re passionate about stuff, and you meet someone who shares your passion, you don’t even know what you’re going to learn.

Dr. Minas Chrysopoulo

Enjoy their experience by listening to the full podcast discussion here.

Disclaimer

References made to my surgical group, surgeon and healthcare team are made because they are aligned with my values and met my criterion after I did research of their practices and success rates. Any other healthcare provider that displays the same skill, compassion education and outreach to patients will be given consideration and recognition on this website.  The information contained on this website is not a substitute for or should be construed as medical advice. Please consult a licensed physician for medical advice.